THE IMPACT OF LIVER-TRANSPLANTATION ON ENDOCRINE STATUS IN MEN

OBJECTIVE There are few longitudinal data on the endocrine changes whi ch occur after liver transplantation. We have therefore studied the im pact of orthotopic liver transplantation (oLTX) on the hypothalamic-pi tuitary-gonadal hormone axis and sex steroid metabolism in men. PATIEN TS AND STUDY DESIGN Ten male patients with end-stage liver failure due to alcohol induced cirrhosis (n=2), virus-induced cirrhosis (n=5), pr imary biliary cirrhosis (n=1) and idiopathic cirrhosis (n=2) were incl uded in a prospective study analysing the impact of oLTX on endocrine status. They were studied before and after oLTX with a mean follow-up of 11.6 months (range 4-23) following transplantation. MEASUREMENTS Se rum levels of LH, FSH, testosterone (TE), free TE, PRL, cortisol, oest radiol (E(2)) and sex hormone binding globulin (SHBG) were analysed wi th commercially available radioimmunoassays in all individuals before and after oLTX. Gonadotrophin releasing hormone stimulation tests were done in 5 patients before and after oLTX. Additionally, a complete ur ological assessment with a detailed questionnaire on sexual function w as obtained from all individuals.RESULTS Prior to oLTX, endocrine stat us was invariably abnormal, the most prominent finding being a patholo gical decrease of TE in 90% and of free TE in all cases. After success ful oLTX, all individuals had physiological levels of TE and of free T E which increased twofold (P < 0.01) and tenfold (P < 0.0001), respect ively. Additionally, serum gonadotrophin (LH/FSH) levels increased in the majority of patients, while E, decreased following oLTX. Endocrine changes extended beyond the hypothalamic-pituitary-gonadal hormone ax is, as shown by a decrease in PRL (P < 0.02) and SHBG (P < 0.01) after transplantation. GnRH tests revealed normal stimulation of LH and FSH before and after oLTX in all cases. Libido, potency and frequency of sexual intercourse improved significantly after oLTX in the majority o f patients. CONCLUSIONS These findings demonstrate the ability of the hypothalamic-pituitary-gonadal hormone axis and sex steroid metabolism to resume physiological function following orthotopic liver transplan tation in men. Correspondingly, sexual function returns to normal in t he majority of patients, despite significant alterations prior to orth otopic liver transplantation.